IntroductionGood non-technical skills (NTS) are critical to the delivery of high-quality patient care. It is increasingly recognised that training in such skills should be incorporated into primary medical training curricula. This study aimed to develop an NTS behavioural marker system (BMS), specifically applicable to medical students, for use within simulated acute care scenarios.MethodsThe methodology used to develop other BMS was adopted and modified. Following ethical approval, 16 final year medical students participated in acute care simulated scenarios. Semistructured interviews were performed to gauge the understanding of NTS. A panel meeting of subject matter experts was convened to translate key NTS into skill elements and observable behaviours. A second expert panel was consulted to refine aspects of the BMS. Further refinement and initial face validity was undertaken by a third panel of experts using the prototype BMS to observe prerecorded simulation scenarios.ResultsFive categories of NTS were identified: situation awareness, teamwork and communication, decision-making and prioritisation, self-awareness, and escalating care. Observable behaviours in each category describe good and poor performance. Escalating care was identified as a unique component that incorporated behaviours related to each of the other four skill categories. A 5-point rating scale was developed to enable both peer-to-peer and tutor-to–student feedback.ConclusionThe Medi-StuNTS (Medical Students’ Non-Technical Skills) system is the first BMS for the NTS of medical students. It reinforces the importance of escalating care effectively. It provides an exciting opportunity to provide feedback to medical students and may ultimately aid their preparedness for professional practice.
Context Non‐technical skills (NTS) training should be incorporated into medical students' education and simulation‐based approaches are often utilised to facilitate this. Such experiences have the potential to foster transformative learning by facilitating a reassessment of one's prior assumptions and a significant shift in one's outlook, referred to as the process of perspective transformation. The aim of this research was to explore how NTS training might facilitate transformative learning in final‐year medical students. Methods Following ethical approval, medical student volunteers from four medical schools (Aberdeen, Dundee, Edinburgh and Glasgow) participated in simulation sessions, were debriefed with an emphasis on NTS using a behavioural marker system and then took part in focus groups. Focus group discussions were semi‐structured and questions were based on the phases of perspective transformation identified by Jack Mezirow. Focus group discussions were audiorecorded, transcribed verbatim, anonymised and analysed using template analysis. Results A total of 33 medical students took part in five focus groups. There was evidence of the following stages of perspective transformation: Phase 2 (self‐examination with emotional disturbance, including fear, anxiety, guilt, shame and frustration); Phase 3 (critical assessment of assumptions, including the undervaluing of NTS, recognising that technical skills alone are insufficient, and recognising that it is possible to improve one’s NTS); Phase 5 (exploring options for new roles, relationships and actions), and Phase 6 (planning a course of action for future simulations, as a medical student and as a doctor). Conclusions This study deepens our understanding of how exposure to NTS training in simulation‐based education influences the learning of medical students and shows that such exposure can result in the cognitive phases of transformative learning. It provides us with valuable insights into medical students' perspectives on their learning of NTS at a pivotal stage in training and represents an interesting way of assessing the educational impact of such sessions.
Introduction Health professional identity transitions involve a dynamic period of liminality prompting a time of considerable uncertainty and self‐doubt. For postgraduate trainees in the United Kingdom, the transition to medical registrar can be a significant deterrent to recruitment and retention. Narrative analysis offers insight into identity work during transitions with potential to inform strategies for developing professional identities. This study aimed to use narrative analysis to explore trainees' experiences and their sense of agency during the liminal phase of this transition. Methods Following ethical approval, internal medicine (IM) trainees in their second year of IM training were interviewed. Transcripts were audio recorded, transcribed verbatim and analysed to identify narratives describing liminality during the transition to the role of medical registrar, including examples of rejecting and claiming identity grants. Narrative analysis, as described by Riessman and influenced by James Gee's units of discourse, was undertaken, with an agentive lens applied to the data. Results Between January 2021 and February 2022, 19 IM trainees were interviewed. Given the in‐depth analysis, four narratives were purposively selected to present, including trainees rejecting and claiming the medical registrar role. Trainees tended to describe negative experiences, but those with a higher sense of agency demonstrated positive reflection and identity construction through narrative. There was often identity dissonance between how trainees defined their stage in the transition to medical registrar and how their narrative illustrated their identity work. Conclusion This study exemplifies narrative analysis' linguistic and agentive lenses in exploring the experience of the liminal identity transitional period. The findings reflect the identity dissonance experienced by trainees during this time and sheds light on their sense of agency throughout. It heralds a need to acknowledge the significant liminality experienced during transitions throughout medical training and to empower a sense of agency to support identity work.
ObjectivesThis study aimed to explore how the COVID-19 pandemic has impacted the workplace core needs of internal medicine (IM) trainees in Scotland.DesignThis qualitative study used an observational approach of interprofessional workshops combined with subsequent individual interviews with IM trainees. Workshops and interviews were audiorecorded, transcribed verbatim and analysed utilising NVivo software. Template analysis was used with the Autonomy/control, Belonging and Competence (ABC) of doctors’ core needs outlined in the 2019 General Medical Council report Caring for doctors, caring for patients as a conceptual lens for the study.SettingThe national IM boot camp in Scotland includes a 2-hour interprofessional workshop which is trainee led and explores current challenges in the workplace, including the impact of the pandemic on such relationships.ParticipantsTwelve workshops, involving 72 trainees, were included with ten trainees taking part in the subsequent interview process. Trainees representing all four regions in Scotland were involved.ResultsTrainees described all core needs having been impacted by the pandemic. They described a loss of autonomy with emergency rotas but also through a pervasive sense of uncertainty. The data revealed that work conditions improved initially with additional resources which have since been removed in some areas, affecting trainees’ sense of value. Analysis found that belonging was affected positively in terms of increased camaraderie but also challenged through inability to socialise. There were concerns regarding developing competence due to a lack of teaching opportunities.ConclusionsUsing the ABC of doctor’s core needs as a conceptual framework for this study highlighted the impact of the COVID-19 pandemic on all domains for IM trainees in Scotland. It has highlighted an opportunity to foster the renewed sense of camaraderie among healthcare teams, while rebuilding work conditions to support autonomy and competence.
Background The transfer of training to the workplace is the aim of training interventions. Three primary factors influence transfer: trainee characteristics, training design and work environment influences. Within medical education, the work environment factors influencing transfer of training remain underexplored. Burke and Hutchins’ review of training transfer outlined five work environment influences: opportunity to perform, supervisor/peer support, strategic link, transfer climate and accountability. This study aimed to explore the ways in which work environment factors influence the transfer of training for medical trainees. Methods Internal Medicine Training in Scotland includes a three-day boot camp involving simulation-based mastery learning of procedural skills, immersive simulation scenarios and communication workshops. Following ethical approval, trainees were invited to take part in interviews at least three months after following their boot camp. Interviews were semi-structured, anonymised, transcribed verbatim and analysed using template analysis. Member checking interviews were performed to verify findings. Results A total of 26 trainees took part in interviews between January 2020 and January 2021. Trainees reported a lack of opportunities to perform procedures in the workplace and challenges relating to the transfer climate, including a lack of appropriate equipment and resistance to change in the workplace. Trainees described a strong sense of personal responsibility to transfer and they felt empowered to change practice in response to the challenges faced. Conclusions This study highlights barriers to transfer of training within the clinical workplace including procedural opportunities, a transfer climate with challenging equipment availability and, at times, an unsupportive workplace culture. Trainees are driven by their own sense of personal responsibility; medical educators and healthcare leaders must harness this enthusiasm and take heed of the barriers to assist in the development of strategies to overcome them.
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